HIV-infected individuals who delay, decline, or discontinue antiretroviral therapy

Comparing clinic- and peer-recruited cohorts

The Heart to Heart Collaborative ResearchTeam

Research output: Contribution to journalArticle

Abstract

A substantial proportion of persons living with HIV/AIDS (PLHA) delay, decline, or discontinue antiretroviral therapy (ART) when it is medically indicated (40-45%), largely African-Americans and Latinos/Hispanics. This study explores the feasibility of locating PLHA, who are not on ART (PLHA-NOA) through clinics and peer-referral; compares the two cohorts on multi-level barriers to ART; and examines readiness to initiate/reinitiate ART, a predictor of treatment outcomes.We recruited adult HIV-infected African-American and Latino/Hispanic PLHA-NOA through HIV hospital clinics and peer-referral in 2012-2013. Participants were engaged in structured 1-h assessments with reliable/valid measures on barriers to ART. We found that recruitment through peers (63.2%, 60/95) was more feasible than in clinics (36.8%, 35/90). Participants were 48.0 years old and had lived with HIV for 14.7 years on average, and 56.8% had taken ART previously. Most (61.1%) were male and African-American (76.8%), and 23.2% were Latino/Hispanic. Peer-recruited participants were older, had lived with HIV longer, were less engaged in HIV care, and were more likely to have taken ART previously. The cohorts differed in reasons for discontinuing ART. Levels of ART knowledge were comparable between cohorts (68.5% correct), and there were no differences in attitudes toward ART (e.g., mistrust), which were in the neutral range. In bivariate linear regression, readiness for ART was negatively associated with physician mistrust (B =-10.4) and positively associated with self-efficacy (B =5.5), positive outcome expectancies (B =6.3), beliefs about personal necessity of ART (B =17.5), and positive internal norms (B =7.9). This study demonstrates the feasibility of engaging this vulnerable population through peer-referral. Peer-recruited PLHA evidence particularly high rates of risk factors compared to those in hospital clinics. Interventions to support ART initiation and continuation are sorely needed for both subgroups.

Original languageEnglish (US)
Article number81
JournalFrontiers in Public Health
Volume2
Issue numberJUL
DOIs
StatePublished - Jul 16 2014

Fingerprint

HIV
Hispanic Americans
Therapeutics
Acquired Immunodeficiency Syndrome
African Americans
Referral and Consultation
Feasibility Studies
Vulnerable Populations
Self Efficacy
Linear Models
Physicians

Keywords

  • African-American
  • Antiretroviral
  • Barriers
  • decline
  • Delay
  • Discontinue
  • HIV
  • Latino

ASJC Scopus subject areas

  • Public Health, Environmental and Occupational Health

Cite this

HIV-infected individuals who delay, decline, or discontinue antiretroviral therapy : Comparing clinic- and peer-recruited cohorts. / The Heart to Heart Collaborative ResearchTeam.

In: Frontiers in Public Health, Vol. 2, No. JUL, 81, 16.07.2014.

Research output: Contribution to journalArticle

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